Culture of Life” Politics at the Bedside — The Case of Terri Schiavo

"Culture of Life" Politics at the Bedside — The Case of Terri Schiavo

  • Introduction

    • Congress convened in a special emergency session on March 20 to legislate specifically regarding Terri Schiavo's medical care, marking a unique event in U.S. history.
    • President George W. Bush supported the legislation, emphasizing a "culture of life" which includes valuing and protecting all Americans, including those with disabilities.
    • The "culture of life" is associated with the anti-abortion movement, potentially seeking to influence laws around human embryos and artificially sustained life for incompetent patients.

  • Questions Raised by the Case

    • Was it appropriate for Congress to intervene in a case already extensively litigated?
    • Has there been a fundamental shift in the country's culture or understanding of the law?
    • Do patients requiring artificial life support present new legal and ethical challenges?

  • The Terri Schiavo Case

    • Terri Schiavo's case, involving a persistent vegetative state, became a public spectacle due to a family dispute over her feeding tube.
    • The case shares similarities with those of Karen Ann Quinlan and Nancy Cruzan, highlighting the complexities in such medical-legal situations.
    • The Schiavo case provides an opportunity to revisit settled issues in law, bioethics, and medicine since the Quinlan (1976) and Cruzan (1990) cases

  • The Case of Karen Quinlan (1976)

    • Quinlan's case involved a persistent vegetative state, with her parents seeking to discontinue ventilator use.
    • Physicians feared legal liability for removing the ventilator.
    • The New Jersey Supreme Court affirmed the right of competent persons to refuse life-sustaining treatment, extending this right to incompetent individuals.
    • The court provided legal immunity to physicians following a prognosis, confirmed by a hospital ethics committee, that there was “no reasonable possibility of a patient returning to a cognitive, sapient state,” life-sustaining treatment can be removed and no one involved, including the physicians, can be held civilly or criminally responsible for the death.
    • This ruling aimed to address physician's fears of legal liability, not ethical concerns.

  • Impact of the Quinlan Case

    • The Quinlan case led to the enactment of “living will” legislation, granting legal immunity to physicians who honored patients' advance directives.
    • Hospitals began establishing ethics committees to resolve treatment disputes internally.

  • The Case of Nancy Cruzan (1990)

    • The U.S. Supreme Court established constitutional law for the entire country.
    • Nancy Cruzan was in a persistent vegetative state and required tube feeding.
    • The Missouri Supreme Court ruled that tube feeding could only be discontinued if there was "clear and convincing" evidence that Nancy would refuse it herself.
    • The U.S. Supreme Court upheld Missouri's high standard of evidence, permitting the state to "err on the side of life."

  • Constitutional Rights and Medical Intervention

    • The Court acknowledged the legal right of Americans to refuse any medical intervention, including artificial nutrition and hydration.

  • Justice O’Connor’s Concurring Opinion

    • Justice Sandra Day O’Connor noted that young people often do not leave explicit treatment instructions.
    • She suggested a statement such as “if I’m not able to make medical treatment decisions myself, I want my mother to make them,” should be a constitutionally protected delegation of the authority to decide about her treatment.
    • Justice O'Connor suggested that a simple statement delegating medical decision-making authority should be constitutionally protected.
    • This opinion spurred the use of health care proxy forms and durable power of attorney assignments.
    • All states authorize delegation, granting decision-making authority to close relatives, typically the spouse, if no prior designation exists.

  • The Schiavo Case in the Courts

    • Terri Schiavo experienced cardiac arrest in 1990 and lived in a persistent vegetative state since then.
    • In 1998, Michael Schiavo petitioned to discontinue tube feeding, opposed by Terri's parents, leading to a family dispute.
    • A judge found clear and convincing evidence that Terri was in a persistent vegetative state and would choose to discontinue life-prolonging procedures.
    • This decision was affirmed by an appeals court, and the Florida Supreme Court declined review.
    • Schiavo’s parents returned to court, claiming that they had newly discovered evidence. After an additional appeal, the parents were permitted to challenge the original court findings on the basis of new evidence related to a new treatment that they believed might restore cognitive function.
    • Five physicians examined Terri, with the majority agreeing she was in a persistent vegetative state.
    • The appeals court quoted the trial judge's sympathetic conclusion regarding the parent's aspirations but emphasized Theresa Schiavo’s right to make her own decision, independent of her parents and independent of her husband.

  • **Legislative Intervention: